I_ECR_BH_2021A 01/05/2022 09:08:44 AM Committee Summary

Jacob Bornstein, Wellstone Strategies, distributed a handout that summarized behavioral health related recommendations for Task Force consideration, including ones that required funding and ones that were policy-oriented.

The handout can be found here:  http://leg.colorado.gov/sites/default/files/images/lcs/bh_draft_recommendations_01_05_22.pdf

The funding recommendations are organized in letter format on pages 1-2. 

Mr. Bornstein explained the review and voting process and answered questions. 

Mr. Bornstein began by reviewing Recommendation A:  Southern Ute Behavioral Health Facility. The committee agreed to go forward with the recommendation.  

Mr. Bornstein proceeded to Recommendations B.1. Youth and Family Residential Care; B.2. Children, Youth, and Families Community Services; and, B.3 School and Pediatric Care BH Integrations.  Task Force members asked questions about expanding facilities to different parts of the state, on-going costs, and overlap with public safety proposals. 

Mr. Bornstein clarified the voting process.  Committee members agreed to move forward with Recommendations B.1,  B.2., and B.3. 

Mr. Bornstein continued to Recommendation C: Adult Residential Care.  Committee discussion ensued about bed numbers and types of facilities. 

The committee had no objections to Recommendation C and agreed to include it in the final report. 

Mr. Bornstein reviewed Recommendation D. Primary Care BH Integrations (formerly SIM).  Task Force members discussed training, cost-benefits, and subpanel priorities.  Clarifying language was recommended, but otherwise the Task Force had no objections to this recommendation and agreed to make it part of the final report. 

Mr. Bornstein next discussed Recommendation  E.1. Community BH Continuum of Care Gap Grants.  Task Force members discussed overlap with other behavioral health services, regional needs, and competency. 

The committee had no objections to Recommendation E.1 and agreed to include it in the final report. 

Mr. Bornstein explained Recommendation E.2. Criminal Justice Grants: Diversion, CJ Early Intervention Program, Intervention, and Competency. 

Task Force and subpanel members suggested clarifying language regarding jail-based competency treatment.  Further discussion ensued about and pre and post arrest language concerning diversion programs.  Task Force members agreed to include Recommendation E.2. in the final report. 

Task Force members discussed the funding allocation.  It was suggested to move funds from the upcoming workforce recommendation (F) and add more into the criminal justice ones (E.1, E.2, and E.3).  Committee members discussed this suggestion and expressed concerns about making cuts to workforce.  The facilitators pointed out that the criminal justice recommendations also addressed workforce issues. 

Mr. Bornstein reviewed Recommendation F. Workforce.  Task Force members discussed scholarships and loan forgiveness.  They also discussed workforce expansion and providers.  Further questions were raised about expanding the provider network and increasing capacity to ensure there is a safety net for individuals in crisis.  Additional comments were made about adding workforce for competency restoration services. 

The Task Force further discussed the funding allocation and agreed to change the workforce and criminal justice funding ranges.  The criminal justice increased to $65 million (low range) to $70 million (high range).  The workforce range changed to $80.3 million (low range) to $82 million (high range).  The Task Force agreed on the new ranges and also decided to move forward with  Recommendation F. Workforce. 

Mr. Bornstein moved to Recommendation G. BH System Investments in Care Navigation & Coordination and Immediate Pandemic Relief.  Committee members noted that parts of this recommendation would better fit in policy, not funding, recommendations.  Otherwise, the Task Force concurred about this recommendation. 

Task Force members discussed contingencies for on-going costs and leveraging funds.  The conversation turned to policy components included in Recommendation G.

Mr. Bornstein discussed the final report and its contents, including but not limited to legislative guidance, parameters of the American Rescue Plan Act funds, process, subpanel meetings, and the working groups.

Mr. Bornstein reviewed the community behavioral health care continuum gap grant framework, located on page 5 of the document linked above. Task Force members discussed parity and outreach to organizations who may be interested in the grants.  Task Force members asked questions about grant administration and the inclusion of tribes.  Further discussion ensued about expectations, levelling the playing field for organizations applying for grants, and a tiered level approach. 

The Task Force broke for lunch. 

The Task Force reconvened at 12:33 pm.  They returned to the discussion about grants and clarified that the new Behavioral Health Administration will administer the grants.  Mr. Bornstein noted that the following language will be added to the grant section of the final report, and include grant administration, high needs areas, tribes, demonstrated need for one-time funding, and reveiw of organizational financial statements. 

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Mr. Bornstein next walked the Task Force members through the policy recommendations, organized in in numerical order on pages 3-4 in the document linked above.  Members agreed on the package of policy recommendations and discussed the following:

• Policy #1 - Reciprocity: Discussion ensued about interstate compacts and licensure across state lines. 
• Policy  #2 - 1115 mental health waiver:  Task Force members discussed Medicaid and substance use disorders.
• Policy #3 - Audit/sunset review of behavioral health line items:  Discussion followed about audit criteria and reversion dollars. 

• Policy #4 - Decrease administrative burden: Members noted that there is work being done on a singular data system. state-wide and cautioned that many administrative requirements are at the federal level.  
• Policy #5 - Judicial diversion:  Task Force members had no objections to the diversion policies proposed. 
• Policy #6  - G88 behavioral health line:  Members discussed funding options for this behavioral health crisis line.
• Policy #7 - Certified addiction technicians and specialists: Members had no objections to this proposal.
• Policy #8 - Discharge strategy: Members engaged in a broad discussion about discharge planning. 

• Policy #9 - Buprenorphine:  Members discussed medication assisted treatment
• Policy #10 - Special competency population: Members discussed the overlap with #11, explained below.
• Policy #11 - Medicaid in the jails, community corrections, Department of Youth Services, and Department of Corrections.  Members discussed Medicaid in correctional settings and application. 
• Policy #12 - Transparency and accountability.  Members discussed this in relation to requirements set forth in Senate Bill 19-222, individuals at-risk of institutionalization. 

• Policy #13 -  Transform payer system and care coordination.  Discussion ensued about funding streams, uniform payer system, regional accountable entities, and consolidation. 

• Policy #14 - Community competency restoration.  Members asked questions about backlogs and tiers of competency restoration.
• Policy #15 - Medication assisted treatment.  Discussion followed about medication assisted treatment in jails and funding. 
• Policy #16  - Insurer therapy coverage.  Questions were raised about the intent of related laws. 
• Policy #17 - Social emotional learning.  Members discussed use in of social emotional learning in schools.
• Policy #18 - Behavioral Health Administration.  Members discussed duplicative committees throughout state departments and questioned the necessity of this recommendation. 

The Chair thanked all involved for their hard work. 

Joseph Bowers, representing himself, discussed mental health issues, peer mentors, and competency restoration. 

Dan and Barb West, representing themselves, discussed their son's mental health crisis and prison.

Deshaun Stewart, representing himself, discussed his mental health disorders and the importance of support systems.

Sandra Sharp, representing herself, provided public testimony about behavioral health system gaps. 

Theresa Schiavone, representing NAMI/Healthcare for Patients iwth Serious and Persistent Mental Illness, provided testimony about her interactions iwith the behavioral health care system.